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CJ CMS > surgical conditions > Flashcards

surgical conditions Flashcards

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1
Q

what scales can be used to assess severity of pain?

A

visual analogue scale 0-10

wong baker pain faces scale

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2
Q

according to WHO analgesic ladder, what should be used for step 1?

A

non opioid

with or without adjuvant analgesic

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3
Q

what should be used for step 2?

A

opiod for mild to moderate pain
plus non opioid
with or without adjuvant analgesic

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4
Q

what should be used for step 3?

A

opiod for moderate to severe pain
plus non opioid
with or without adjuvant analgesic

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5
Q

what is a simple analgesic?

A

paracetamol

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6
Q

examples of NSAIDs

A

aspirin
ibuprofen
diclofenic
naproxen

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7
Q

examples of weak opiates

A

codeine
dihydrocodeine
co- codomol

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8
Q

example of a moderate opiate?

A

tramadol

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9
Q

examples of strong opiates?

A

morphine
oxycodone
pethidine

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10
Q

when is diclofenac contra indicated?

A

in cardiovasculer disease

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11
Q

when is pethidine not recommended?

A

post operatively

as it is metabolised in the renal system

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12
Q

what may opiates cause?

A

respiratory depression

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13
Q

When should caution be taken with NSAIDS?

A 
hepatic impairment
renal impairment
pregnancy- generally avoided
GI pathology
asthma
cardiovascular events
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14
Q

how can opiate toxicity present?

A 
reduced consciousness
pin point pupils
hypotensive
cyanosis
muscle spasm
seizure
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15
Q

how should opiate toxicity be managed?

A

ABCDE

naloxone

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16
Q

What is naloxone?

A

opiod antagonist

17
Q

how does naloxone work?

A

reverses CNS depression, respiratory depression and hypotension

18
Q

What dosage should naloxone be given in?

A

0.4- 2 mg IV

intervals of 2-3 minutes

19
Q

what is the maximum dosage of naloxone?

A

10mg

20
Q

what are possible investigations re. constipation?

A 
exam
rectal examination
abdominal xray
barium study
colonoscopy
21
Q

when is a reactionary haemorrhage most common?

A

4-6 hours post op

22
Q

when does a secondary haemorrhage occur?

A

7-14 days post op

23
Q

what can secondary haemorrhage be caused by?

A

due to infection or eroded vessel

24
Q

What can cause post operative hypotension?

A 
bleeding
dehydration
sepsis
opiate overload
spinal anaesthesia
refractory anaesthesia
25
Q

what indicates pyrexia in the surgical patient?

A

a temperature over 37.5 degrees

26
Q

What are the sepsis 6?

A 
deliver high flow oxygen
administer IV antbiotics
administer IV fluids
take bloods
take swabs
measure urine
27
Q

what measures should be taken if patient pyrexic post operatively?

A 
check obs
check IV access lines, catheter, wounds
take blood cultures
test urine- dipstick and c+s
swabs
ECG or ECHO if indicated
28
Q

what are possible causes of post operative pyrexia?

A 
day 1-2: acetlectasis
day 3-4: pneumonia
day 5-6: anastomtic leak
day 7-8: wound infection
day 9+ : DVT or PE
29
Q

what is ACS?

A

acute confusional state

30
Q

who is ACS common in post operatively?

A 
elderly
those with exsiting cognitive impairment 
psychiatric morbidity
sensory impairment
dehydrated, malnourished
drug or alcohol depandance
31
Q

what is hypochloremic alkalosis?

A

low chloride and high bicarbonate

32
Q

what is hypokalaemia?

A

low potassium

33
Q

what can hypokalaemia cause?

A

cardiac arythmia

34
Q

what is a mallory- weiss tear?

A

tear in junction of stomach and oseophagus

35
Q

how does mallory weiss tear present?

A

repeat or profuse vomitting

CJ CMS (17 decks)

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